Provider Demographics
NPI:1376530873
Name:BRAY, DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BRAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-0726
Mailing Address - Country:US
Mailing Address - Phone:520-387-7833
Mailing Address - Fax:520-387-7885
Practice Address - Street 1:24 N PLAZA ST
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-2464
Practice Address - Country:US
Practice Address - Phone:520-387-7833
Practice Address - Fax:520-387-7885
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU51889Medicare UPIN
AZZ63376Medicare PIN
AZZ60250Medicare PIN